Is laser good or bad for melasma?

Part of: Melasma & pigmentation

Laser may improve melasma in selected cases, but it is not a button that erases pigment, and relapse and pigment complications are a real part of the decision. Studies of low-fluence Q-switched Nd:YAG laser for melasma point to a possible overall benefit, but results differ a lot, spotty loss of pigment can sometimes last, and aggressive use and high cumulative energy can cause darkening, especially in darker skin. Some studies recorded significant relapse after 3 months, and long-term follow-up was not enough to give one reliable relapse rate.

Key numbers

  • 42 studies — Studies in the review
  • 3 months — A documented relapse window
  • Does not exist — A universal relapse figure
  • Spotty loss of pigment — An important complication

When should I consider laser?

  • After sun protection and core topical treatment are in place, rather than using laser as an automatic first step.
  • With a clear diagnosis of melasma and an assessment of Fitzpatrick skin type and post-inflammatory pigmentation risk, not just because there is brown color on the face.
  • When the patient understands that the goal is usually improvement and control, not a permanent cure.
  • With a conservative protocol and monitoring for relapse and pigment changes, rather than the idea that more energy gives a better result.

Key takeaways

  • Laser can help, but it is not necessarily the first step or the most lasting treatment for melasma.
  • Aggressive repetition can cause darkening or spotty loss of pigment instead of improvement.
  • If someone gives you one relapse rate for every melasma device and every skin type, that number is not scientific.

Which Laser for Which Problem? CO₂, RF Microneedling and IPL

Medical references

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